E2 ModeratePreliminaryPEM unclearCross-SectionalPeer-reviewedMachine draft
Detection of mycotoxins in patients with chronic fatigue syndrome.
Brewer, Joseph H, Thrasher, Jack D, Straus, David C et al. · Toxins · 2013 · DOI
Quick Summary
Researchers tested urine samples from 112 ME/CFS patients to see if they had been exposed to mycotoxins—toxic substances produced by mold found in water-damaged buildings. They found that 93% of patients had detectable mycotoxins in their urine, with most patients having been exposed to moldy buildings. When they tested urine from 55 healthy people with no mold exposure, none showed mycotoxins at detectable levels.
Why It Matters
This research suggests a potential environmental exposure pathway in ME/CFS, specifically mold and mycotoxins from water-damaged buildings. Understanding environmental triggers could help patients identify avoidable exposures and inform investigations into mechanisms of ME/CFS.
Observed Findings
- Ninety-three percent (104/112) of CFS patients had detectable mycotoxins in urine compared to 0% of 55 healthy controls.
- Ochratoxin A was present in 83% of CFS patients; macrocyclic trichothecenes in 44%.
- Almost 30% of CFS patients had more than one mycotoxin detected simultaneously.
- Over 90% of CFS patients reported current or past exposure to water-damaged buildings.
- Environmental testing of water-damaged buildings from a patient subset confirmed presence of mycotoxin-producing mold species.
Inferred Conclusions
- Mycotoxin exposure from water-damaged buildings may be a significant exposure factor in CFS patients.
- The high concordance between WDB exposure history and mycotoxin detection suggests an environmental source of mycotoxin burden.
- Ochratoxin A is the most prevalent mycotoxin exposure marker in this CFS population.
Remaining Questions
- Does mycotoxin exposure cause CFS, or are both markers of a common factor (e.g., genetic susceptibility to environmental toxins)?
- What is the temporal relationship—were mycotoxins present before symptom onset, or did exposure occur after CFS developed?
What This Study Does Not Prove
This study does not prove that mycotoxins cause ME/CFS, only that they are detected more frequently in CFS patients than in controls without WDB exposure. The cross-sectional design cannot establish causation or determine whether mycotoxin exposure preceded illness onset. It also does not show whether mycotoxins directly cause CFS symptoms or whether they are markers of a broader environmental exposure.
Tags
Symptom:Fatigue
Biomarker:Blood Biomarker
Method Flag:Weak Case DefinitionExploratory Only
Metadata
- DOI
- 10.3390/toxins5040605
- PMID
- 23580077
- Review status
- Machine draft
- Evidence level
- Single-study or moderate support from human research
- Last updated
- 8 April 2026
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
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